Surgical Treatment for Endometriosis

Endometriosis is rare in puberty, even though signs and symptoms of endometriosis can start with the first menstrual period. After menopause, the signs and symptoms of endometriosis disappear due to the lack of hormones.

As mentioned, there is no cure for endometriosis. However, treatment includes methods for relieving the pain, and methods for treating infertility caused by endometriosis as one of the greatest complications of endometriosis. 

When determining the best treatment for endometriosis, your doctor will consider several factors:

• severity of the signs and symptoms
• the severity of the disease
• whether you want children or not
• your age

Always keep in mind that there is no guarantee that the signs and symptoms won't return after the treatment. In many cases, the signs and symptoms may return if the treatment is stopped or even after the surgery. The more time that has passed from the last treating cycle or from the last surgical treatment, the greater the chances of developing signs and symptoms of endometriosis.

Pain treatment for endometriosis

• Pain medications – are usually recommended in mild to moderate cases. The most common pain medications used for treating endometriosis are NSAIDS and opioids.
• Hormone therapy – works by stopping the ovaries to produce hormones, including estrogen. This prevents the endometrial lesions to grow and spread. Hormone therapy consists in taking oral contraceptives, progesterone, Danazol or GnRH agonists.
• Surgical treatment – is usually recommended in severe cases.
  • There are two types of surgical treatment: laparoscopic treatment and laparotomy.

Laparoscopic treatment – is considered a mini-invasive surgical method. Two small incisions are usually done near the navel, through which gas is first inflamed inside the abdomen. This helps distend the abdomen and push away the organs from the abdominal wall, in order to have a better view and working place. Through the incisions, an instrument called Laparoscope is inserted into the abdomen. A laparoscope is a tube with a camera and light, which helps the surgeon see inside of the abdomen and pelvis. With the help of laparoscopy, endometriosis lesions can be diagnosed and treated. Also, in many cases when we suspect for endometriosis, but no lesions can be seen, some samples of the tissues are taken for biopsy. Endometrial lesions can be very small and even microscopic in many cases. A great advantage of the laparoscopic treatment of endometriosis is that the recovery period is shorter when compared to conventional surgery. There is a less chance of any possible complication.

Laparotomy – is a major surgery of the abdomen. The recovery period is longer and there are bigger chances of complications when compared to a laparoscopic treatment of endometriosis. During the procedure, the surgeon removes the endometrial lesions that are found outside of the uterus. However, in many cases, the lesions are two small and they can’t be seen with naked eye. When the endometriosis is widely spread and the lesions are found in many organs of the abdomen and pelvis, there is the possibility of removing the uterus, ovaries, Fallopian tubes as well. The procedure is called totally, hysterectomy with bilateral salpingo-oophorectomy. Major surgery like laparotomy is the last treating step of endometriosis. Having a hysterectomy or salpingo-oophorectomy does not guarantee that the lesions will not return or that the pain will go away.

Surgery to severe pelvic nerves – in many cases when the pain is severe and it can’t be controlled with any other method, there is a chance of cutting the nerves of the pelvis in order to lessen the pain. This procedure can be performed either during laparoscopy or laparotomy.

There are two procedures used:

• Laparoscopic uterine nerve ablation
• Presacral neurectomy.